Patch repair of congenital diaphragmatic hernia is not at risk of poor outcomes

AbstractThe health-related quality of life (HRQoL) of survivors of congenital diaphragmatic hernia (CDH) is presently unknown. Literature prior to 2015 suggests that CDH survivors have worse HRQoL compared with the general population. However, due to changes in the diagnosis, management, and follow-up of CDH patients, this may no longer be true. The objective of this review was to determine what recent literature suggests regarding the HRQoL of CDH survivors. We reviewed all studies published between April 9, 2015, and April 6, 2020, that described the HRQoL of CDH survivors. Studies were identified using PubMed, and the references of the identified papers were searched for additional studies eligible for inclusion. Seven studies describing HRQoL in CDH survivors using validated measures of HRQoL for children, PedsQL (Pediatric Quality of Life Inventory), KIDSCREEN-52, and Comprehensive Quality of Life Scale – School Version were examined. The findings were disparate. One study suggested that CDH survivors had better than average HRQoL scores, three studies found patients and controls had equivalent scores, and two studies reported poor outcomes for CDH patients. The final study found no effect of disease severity on HRQoL, as determined by prenatal ultrasound. Evidence published between 2015 and 2020 suggests that CDH patients have an HRQoL equivalent to the general population.

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Thoracoscopic treatment of chylothorax after patch repair of congenital diaphragmatic hernia

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2010.06.018 ◽

2010 ◽

Vol 45 (8) ◽

pp. 1748-1750 ◽

Cited By ~ 3

Author(s):

Hiroaki Komuro ◽

Sumi Kudou ◽

Masaki Matsubara ◽

Noriko Hoshino

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Patch Repair

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Lyophylized dura patch repair of congenital diaphragmatic hernia: Occurrence of relapses

Journal of Pediatric Surgery ◽

10.1016/0022-3468(93)90027-i ◽

1993 ◽

Vol 28 (5) ◽

pp. 667-668 ◽

Cited By ~ 29

Author(s):

V.C.M. Koot ◽

J.H. Bergmeijer ◽

J.C. Molenaar

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Patch Repair

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Predictors of Long-Term Pulmonary Morbidity in Children with Congenital Diaphragmatic Hernia

European Journal of Pediatric Surgery ◽

10.1055/s-0038-1676586 ◽

2018 ◽

Vol 29 (01) ◽

pp. 120-124 ◽

Cited By ~ 3

Author(s):

Robin Wigen ◽

Wenming Duan ◽

Theo Moraes ◽

Priscilla Chiu

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Pulmonary Function Tests ◽

Forced Expiratory Volume ◽

Patch Repair ◽

Recorded Data ◽

Pulmonary Morbidity

Purpose The aim is to identify prognostic markers of long-term pulmonary morbidity among congenital diaphragmatic hernia (CDH) survivors. Methods A single-institution, retrospective review was performed on all CDH patients from 2000 and 2012 (REB#1000053383). Liver position, patch use, and pulmonary function tests (PFTs) (forced expiratory volume at 1 second [FEV1] and forced vital capacity [FVC] expressed as mean % predicted + SD) were recorded. Data were analyzed using analysis of variance. Results Patients with acceptable and reproducible PFT (n = 72 for 202 total PFT) with patch repair and liver up (n = 28) had significantly lower FEV1 (72.4 + 17.6) than those with no patch and liver down (n = 98, FEV1= 86.3 + 15.9, p = 0.002). Patients with patch repair and liver down (n = 40) also had significantly lower FEV1 (76.6 + 14.4) than those with liver down and no patch (p = 0.0463). Patients with liver up and patch repair had PFT results consistent with moderate reduction of lung function, while the remainder had mild to no decrease in lung function. All CDH patients older than 14 years had a reduction in FEV1/FVC consistent with obstructive phenotype, with a mean FEV1/FVC = 62.3 for patch repair group and FEV1/FVC = 76.1 in the no patch group. Conclusion Decreased pulmonary function of CDH survivors correlated with the use of patch repair and liver position. CDH lung disease should be monitored in adulthood.

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A systematic review and meta-analysis of surgical morbidity of primary versus patch repaired congenital diaphragmatic hernia patients

Scientific Reports ◽

10.1038/s41598-021-91908-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kim Heiwegen ◽

Ivo de Blaauw ◽

Sanne M. B. I. Botden

Keyword(s):

Small Bowel ◽

Congenital Diaphragmatic Hernia ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Diaphragmatic Hernia ◽

Surgical Complications ◽

Meta Analysis ◽

Patch Repair ◽

Surgical Morbidity ◽

Meta Analyses

AbstractLarge studies comparing the surgical outcome of primary versus patch repair in congenital diaphragmatic hernia (CDH) patients are rare. This study aims to evaluate the incidence of surgical complications in both types of CDH repair. PubMed, EMBASE, Cochrane and Web of Science were searched for peer-reviewed articles. Studies on CDH between 1991 and August 2020 were systematically screened and meta-analyses were performed. Primary outcomes of this review were: haemorrhage, chylothorax, recurrences and small bowel obstruction (SBO). A total of 6436 abstracts were screened, after which 25 publications were included (2910 patients). Patch repaired patients have a 2.8 times higher risk on developing a recurrence (20 studies) and a 2.5 times higher risk on developing a chylothorax (five studies). Moreover, they have a two times higher risk on developing a SBO. No studies could be included that evaluated the incidence of surgical haemorrhage between these patients. Although the quality of the studies was relatively low, patch repaired patients have a higher risk on developing a recurrence, chylothorax and small bowel obstruction. Large prospective studies are required to adjust for severity of disease, to reveal the true causative factors in order to minimize the risk on these surgical complications in both types of patients.

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Thoracoscopic patch repair of a right-sided congenital diaphragmatic hernia in a neonate

Surgical Endoscopy ◽

10.1007/s00464-008-0071-1 ◽

2008 ◽

Vol 23 (1) ◽

pp. 215-215 ◽

Cited By ~ 6

Author(s):

Sohail R. Shah ◽

George K. Gittes ◽

Katherine A. Barsness ◽

Timothy D. Kane

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Patch Repair

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Impact of Prophylactic Fundoplication on Survival without Growth Disorder in Left Congenital Diaphragmatic Hernia Requiring a Patch Repair

The Journal of Pediatrics ◽

10.1016/j.jpeds.2010.06.009 ◽

2010 ◽

Vol 157 (4) ◽

pp. 688-690.e1 ◽

Cited By ~ 20

Author(s):

Anne Dariel ◽

Jean-Christophe Rozé ◽

Hugues Piloquet ◽

Guillaume Podevin

Keyword(s):

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Patch Repair ◽

Growth Disorder

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Persisting Motor Function Problems in School-Aged Survivors of Congenital Diaphragmatic Hernia

Frontiers in Pediatrics ◽

10.3389/fped.2021.729054 ◽

2021 ◽

Vol 9 ◽

Author(s):

Sophie de Munck ◽

Monique H. M. van der Cammen-van Zijp ◽

Tabitha P. L. Zanen-van den Adel ◽

René M. H. Wijnen ◽

Suzan C. M. Cochius-den Otter ◽

...

Keyword(s):

At Risk ◽

Congenital Diaphragmatic Hernia ◽

Linear Model ◽

Motor Function ◽

Diaphragmatic Hernia ◽

General Linear Model ◽

Function Impairment ◽

Z Scores ◽

Ecmo Treatment

Background and Objectives: Children born with congenital diaphragmatic hernia (CDH) and treated with extracorporeal membrane oxygenation (ECMO), are at risk for motor function impairment during childhood. We hypothesized that all children born with CDH are at risk for persistent motor function impairment, irrespective of ECMO-treatment. We longitudinally assessed these children's motor function.Methods: Children with CDH with and without ECMO-treatment, born 1999–2007, who joined our structural prospective follow-up program were assessed with the Movement Assessment Battery for Children (M-ABC) at 5, 8, 12 years. Z-scores were used in a general linear model for longitudinal analysis.Results: We included 55 children, of whom 25 had been treated with ECMO. Forty-three (78%) were evaluated at three ages. Estimated mean (95% CI) z-scores from the general linear model were −0.67 (−0.96 to −0.39) at 5 years of age, −0.35 (−0.65 to −0.05) at 8 years, and −0.46 (−0.76 to −0.17) at 12 years. The 5- and 8-years scores differed significantly (p = 0.02). Motor development was significantly below the norm in non-ECMO treated patients at five years; −0.44 (−0.83 to −0.05), and at all ages in the ECMO-treated-patients: −0.90 (−1.32 to −0.49), −0.45 (−0.90 to −0.02) and −0.75 (−1.2 to −0.34) at 5, 8, and 12 years, respectively. Length of hospital stay was negatively associated with estimated total z-score M-ABC (p = 0.004 multivariate analysis).Conclusion: School-age children born with CDH are at risk for motor function impairment, which persists in those who received ECMO-treatment. Especially for them long-term follow up is recommended.

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